Tree Nut Allergy and Tree Nut Free Diet

Tree nut allergy and tree nut free diet

What are tree nuts? tree nuts often happens the first time a child is known to eat the nut, often around 2-4 years of age. The term tree nut is used to mean nuts including: How common is tree nut allergy?  Almond,  Brazil, In Western communities, about 1 in 500 children (0.2%)  Cashew, have a reaction to tree nuts by the age of 5 years. Allergy  Chestnut, to some tree nuts, e.g. cashew nut, is becoming more  Hazelnut, common. Children are more likely to have a tree nut  Hickory, allergy if they have other allergic diseases (asthma, atopic  Macadamia, dermatitis, and other food allergies).  Pecan What are the symptoms of tree nut allergy?  Pistachio  Walnut Reactions can range from mild to severe. These are different from peanuts (known as groundnuts) Mild to moderate reactions include: because tree nuts come from a different plant family.  hives or welts People who are allergic to peanuts are not always allergic  swelling of the lips/face/eyes to tree nuts. People who are allergic to one tree nut are  tingling of the mouth often allergic to other tree nuts. (Pine nuts are seeds.  abdominal pain or vomiting. Coconuts are not tree nuts) Severe reactions (anaphylaxis) include: What is tree nut allergy?  difficulty/noisy breathing Tree nut allergy is a reaction that happens soon after  swelling of the tongue eating tree nuts. The symptoms can be within minutes  swelling or tightness in the throat but can be up to 2 hours after eating the nut. These  difficulty talking and or hoarse voice symptoms are due to your child having IgE (allergy)  wheeze or persistent cough antibodies against nut proteins.  persistent dizziness or collapse, pale and floppy (in In a recent study of Australian nut allergic children, young children). allergy to peanut was the most common (83%), followed Sometimes symptoms of a severe reaction happen by cashew (13%) and other nuts (4%) (almond and pecan, without symptoms of a milder reaction first. It is rare (but hazelnut and walnut). An allergic reaction to possible) for these severe symptoms to occur alone without hives and/or vomiting.

This document was last reviewed on 12 February 2020 © The Children’s Hospital at Westmead, Sydney Children’s Hospital, Randwick and John Hunter Children’s Hospital, Newcastle. page 1 of 3

Reactions to cashew nut are likely to be severe. Very Is my child likely to have a severe reaction rarely very sensitive individuals have died from the from casual contact with tree nuts on benches, severe allergic reaction (anaphylaxis). other children's hands or by smelling tree How is tree nut allergy diagnosed? nuts? Often the first sign of a tree nut allergy is symptoms soon No, severe reactions have not occurred after touching or after eating the nut. You can have your child tested for smelling tree nuts without nut ingestion. Some people the presence of allergy IgE antibodies to a nut with an can develop localised symptoms e.g. hives where the nut allergy skin prick test or a blood test (called a serum touches the skin and this has the same meaning as a specific IgE test). Not every child with a positive allergy positive skin test. A small number of nut allergic people test will develop symptoms after eating that nut. Discuss are sensitive to such small amounts of nuts that they may your child’s test results with your doctor. develop symptoms from eating trace amounts of nuts. If your child has a positive allergy test, but has never Some very sensitive people may develop wheezing if they eaten tree nuts, your doctor will discuss the chance of inhale nut vapours (formed during cooking) but this is developing a reaction. The allergy tests are not very rare. helpful in telling whether a reaction to nut will be mild or What is an Epipen? severe. An Epipen also called an autoinjector, is an emergency Can my child also react to peanuts? device that injects a dose of adrenaline into the muscle in There is a low rate of children being allergic to both the leg. They are used to treat severe reactions to nuts peanuts and tree nuts. Children with a nut allergy are (anaphylaxis). The drug adrenaline reverses the severe more likely to be allergic to other tree nuts than to allergic reaction, and can be lifesaving. peanuts. E.g., a child with a cashew nut allergy is more Should my child carry an adrenaline likely to react to a pistachio nut (tree nut) than a peanut. autoinjector? Will my child react to all types of nuts? All allergists agree that children who have had a serious It is unlikely that your child will react to all types of nuts; reaction involving their breathing should have an however, allergic reactions to more than one nut are adrenaline autoinjector. The need for other children to common. Most (>80%) school age children with a nut have an adrenaline autoinjector depends on many factors allergy will have a positive allergy test to at least one which you can discuss with your doctor. other type of nut. Some children may react to only one If you have an adrenaline autoinjector it is very important type of nut; however, it may be easier to avoid all types that you understand how and when to use it and that you of nuts, as foods that contain tree nuts often contain have a written anaphylaxis action plan from your doctor. more than one type of nut so it is not always possible to be sure which tree nuts are present in a food. Reactions Can I prevent nut allergy in my future children? to tree nuts may increase with age. For this reason your There is no evidence that avoiding nuts in pregnancy or in doctor may repeat the allergy tests to a range of nuts the diet while breastfeeding prevents nut allergy in from time to time. Talk to your doctor about which nuts babies. Current recommendations include no smoking for your child should not eat. either parent, introduction of solids between 4-6months Can my child grow out of tree nut allergy? (unless your child is food allergic) and breastfeeding for at least 6 months if possible. About 10% of children will grow out of their tree nut allergy. Most preschool children who have tree nut How do I avoid exposing my child to tree nuts? allergy will still be allergic during their primary school and Avoiding nuts can be difficult as they are hidden in many teenage years. Children who have more severe allergic foods, especially the following: reactions are less likely to grow out of their allergy. Your child can have an allergy test or supervised challenge in  Baked goods – biscuits, cakes, pastries hospital to see if the nut allergy is still present.  Chocolates, ice cream and confectionery/lollies (e.g. Sometimes the nut allergy can come back in people who Turkish delight) have outgrown their allergy.  Breakfast cereals, muesli, dried fruit mix  Pesto, pasta sauces, salad dressings  Asian food, stir fry, vegetarian dishes

It is important to: What about foods with a label that says "may  know which nuts to avoid contain traces of nuts"?  learn to how to read food labels carefully - always Many foods carry a warning on the label "may contain check the food list on the label even if it says “nut-free” traces of nuts." This means that the food could have or is a product you have used before. The following is been exposed to tree nuts or peanuts anywhere from the an example of a food label: field in which it grew to the factory where it was produced. However unless there is a mistake the food does not usually contain any nut as an ingredient. Some Allergenic ingredients are named in bold each time they appear foods are more likely to be contaminated with nuts than others, especially if they are made on the same machinery as foods containing nuts e.g. chocolate, ice-

cream and muesli bars. Discuss what to do about foods Ingredients: Wheat flour, vegetable oil, sugar, cornflour labelled "may contain traces of nuts" with your doctor. (wheat), Hazelnuts, salt, milk solids, sesame, raising agents (E330, E 341, E500), yeast, emulsifier (E322. Soy), This sheet is a guide to avoiding nuts in your child’s egg. diet. Nuts are found in a variety of foods, often in Contains wheat, hazelnuts, milk, sesame, soy and egg foods we don’t think about such as chocolate, cereal bars/muesli bars, breakfast cereals and bakery

items. Your doctor may advise you to avoid a single

Summary statement Type of nut is specified nut, all types of nuts or a combination of nuts. listing all allergenic ingredients starting with the word ‘contains’

Where can I find more information on the Internet

 understand the different words used that can be used  The Australian Society of Clinical Immunology and to describe tree nuts e.g. almond meal is ground Allergy (ASCIA) website contains useful almond nuts information on food allergy written by Australian  avoid foods that don’t have a food label or that you specialists: www.allergy.org.au. haven’t made yourself, as there is no guarantee that  The patient support group Anaphylaxis Australia the food doesn’t contain nuts offers valuable updates and tips for dealing with  plan eating out and travelling and talk to staff serving food allergies: www.allergyfacts.org.au. you about your child’s allergy  The patient support group Anaphylaxis Australia  avoid food that is served using spoons/tongs that are offers valuable updates and tips for dealing with also used to serve food containing nuts (e.g. some food allergies (www.allergy.org.au) takeaway meals)  Food Standards Australia and New Zealand for  prepare safe meals at home for your child to take out information on food labelling:  change favourite recipes at home by replacing the nuts www.foodstandards.gov.au with rice bubbles or coconut  teach your child about their allergy

Note:

 Beans (legumes) nutmeg and coconuts are not closely related to tree nuts and are usually allowed in the diet unless the child has reacted to one of these before.  Highly refined nut oils are unlikely to cause a reaction in those with a nut allergy. Avoid nut oil which is cold pressed, expressed or expelled.